Rehabilitation

At the beginning of rehabilitation, existing secondary disorders, functional limitations and mental stress should be identified. For this purpose, an initial medical examination is carried out, as well as any necessary laboratory or other technical examinations. The patient's ability to cope with the disease is assessed by means of an initial psychological interview, any further interviews that may be necessary, and additional diagnostic tests. The nursing history determines the current status of self-help competence and any necessary nursing requirements. In addition, if necessary, a status survey is carried out as part of individual physiotherapy or ergotherapy to identify functional deficits and to determine therapeutic strategies. In the same way, a sports medicine baseline assessment is carried out with a survey of previous sports experience, determination of sports therapy objectives and existing limitations or risk factors.

Rehabilitation diagnostics are used to define rehabilitation goals, for example:

• Increasing physical performance, improving fitness and endurance performance, increasing muscle strength, improving mobility and body movement , motivation to intensify physical activities.

• Psychological stabilization, support of disease processing, self-esteem strengthening, improvement of self-help ability and quality of life.

• Nutrition therapy: information on disease-adapted nutrition

• Health training: improvement of the level of information about the disease, instruction in health-conscious lifestyles

• Training social skills, regaining a daily structure: Especially with younger patients, "normality" often needs to be re-practiced in the group.

• Family and social reintegration, reintegration into school, training, study or work: social counseling, career identification, potential analysis, job application training.

• In the case of permanent physical or psychomental deficits with a difficult return to school, training or working life, re-planning of the educational or professional career

• If required, medical-occupational rehabilitation (MBOR) in cooperation with a vocational promotion center.

Once the rehabilitation goals have been defined, the patient, physician and therapeutic team jointly develop a rehabilitation program that pursues the previously defined goals using various therapy modalities. For physical reactivation, (partially) standardized and combined strength endurance training on the machine (medical training therapy) is typically used. This training is supplemented by guided endurance training (ergometer bike training, training on the cross trainer and/or as well as running/walking/Nordic walking). You can contribute to the success of the therapy through independent training, which you record. Other therapy options for training balance, coordination and mobility include step aerobics, water gymnastics, Aerofit (group training with game elements) and climbing on the climbing wall. We have summarized further information in AYApedia Exercise and Sport. In the case of specific restrictions, targeted individual therapy is provided, e.g. physiotherapy, occupational therapy, massages, balneotherapy and other physical procedures.

In the case of severe functional limitations, physiotherapy is the focus of rehabilitation; if necessary, optimization of the provision of aids (e.g. insoles) by orthopedic technology is required.

Group discussions and, if necessary, supplementary individual discussions are used for psychological stabilization. In social counseling, important decisions are made regarding reintegration into training/studies or work. Further information can be found in AYApedia Psychooncology.

If necessary as a result of the disease or therapy, additional nutritional counseling/nutritional therapy is provided. Further information on nutrition after cancer therapy can be found in AYApedia Nutrition.

The course of recovery is monitored in weekly medical visits (more frequently if necessary). In addition, the therapeutic team accompanies the rehabilitation process in daily exchanges and regular meetings. A currently ongoing cancer therapy is continued as well as necessary wound care, stoma therapy, parenteral nutrition, catheter care, etc.

At the end of rehabilitation, there is a socio-medical performance assessment by the attending physician, which shows the possibilities for further training/studies or professional activity. Socio-medically relevant are those restrictions that are likely to have a negative effect on training/studies or occupation over a longer period of time (more than 6 months) or permanently.

Cancer in adolescence or young adulthood often leads to a change in the content and/or timing of the work situation (change of training/study/job may be necessary). Reintegration into school, training and work after completion of treatment must take into account both somatic and psychosocial aspects. It must be decided whether the previous education (school, apprenticeship or study) or professional activity can be continued, taking into account the physical/psychosocial restrictions. Obstacles include not only physical factors but also limitations in memory performance and psychological stress factors. Reintegration into school/training or work should take place as soon as possible, ideally directly after the rehabilitation measure, so that the self-confidence, motivation and daily structure achieved during rehabilitation are not lost again. In the case of an existing job, gradual reintegration is a valuable instrument for this purpose. In the case of school, training or studies, it may be important to define measures for compensation of disadvantages from a medical point of view.

If the rehabilitation directly follows the initial treatment in the hospital, then it is initiated by the social service there (follow-up rehabilitation = follow-up treatment = AHB). If rehabilitation is not possible immediately after hospital treatment, an application for rehabilitation can be submitted later to the relevant pension or health insurance company with the support of the attending specialist. The application should be accompanied by a medical statement (e.g. current report on findings, hospital report or expert opinion).

Outpatient rehabilitation is also possible. However, there are only a few facilities that specialize in treating adolescents and young adults. If one lives near such a facility, then rehabilitation can certainly be done on an outpatient basis.

According to § 8 of the German Social Code IX (SGB IX), you as a patient have a right of choice, i.e., you can choose your preferred clinic for the implementation of rehabilitation. The clinic of your choice must be accredited by the German Pension Insurance for the performance of oncological rehabilitation in the corresponding field. The social service advises and supports you in the choice of clinic and knows the rehabilitation facilities approved by the German Pension Insurance.

Rehabilitation clinics that rehabilitate adolescents and young adults have developed concepts that run over a total rehabilitation period of 4 weeks ("normal" rehabilitation only 3 weeks). The rehabilitation is carried out in a group of mostly 10-12 participants, where affected persons aged 16-18 (adolescents) or 18-32 (young adults) are rehabilitated together. The respective groups have their own spatial areas, both for treatment and leisure. In addition to more intensive psychological care, there are also educational activities outside of regular therapy hours / during free time (evenings and weekends).

There are rehabilitation clinics that offer rehabilitation for mothers or fathers with accompanying children. Depending on the age, your child will be looked after in kindergarten or school while you complete your rehabilitative treatments.

A second oncological rehabilitation is possible up to the end of the second year after the end of acute treatment, provided there is a medical necessity for this. The medical necessity should be proven at the time of application by means of corresponding medical expert opinions/discharge reports/findings reports. Insured persons who are capable of working, for whom the German Pension Insurance is the service provider, and who have not permanently retired from working life, can apply for medical rehabilitation every 4 years, provided that certain insurance periods have been fulfilled. In urgent medical cases, such rehabilitation can also be applied for before 4 years have elapsed (valid justification by the treating general practitioner or specialist).

If the previously performed occupational activity can be resumed and the re-entry is to take place over several load levels, there is the possibility of a gradual reintegration. In this case, the workload usually begins with 2-3 hours per day and increases over a period of 4 weeks to the regular number of hours. If the gradual reintegration is to begin within 4 weeks after the end of rehabilitation, the rehabilitation clinic can initiate the gradual reintegration. If recovery takes longer, initiation of gradual reintegration is the responsibility of the attending specialist or general practitioner.